决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Anti-CCR9 CAR T Cells for T Cell Leukaemia/Lymphoma
这是一项 I 期注册临床试验,评估 T 细胞治疗急性淋巴细胞白血病、淋巴瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 24 例。试验地点:欧洲 · 伦敦(共 1 个中心)。登记号:NCT07300683。
不限性别
主要纳入标准:复发或难治性T细胞急性淋巴细胞白血病(T-ALL)/T细胞淋巴母细胞淋巴瘤(T-LBL),既往接受过至少1线(成人≥18岁)或2线(<18岁)标准联合细胞毒治疗;流式细胞术确认疾病CCR9阳性;T-LBL患者须有可测量病灶;同意接受妊娠检测并在适用时采取充分避孕;签署书面知情同意书。 主要排除标准:ECOG评分>2(≥10岁)或Lansky评分≤50%(<10岁);既往干细胞移植者有活动性显著急性移植物抗宿主病(GvHD)或需免疫抑制治疗和/或全身类固醇的中重度慢性GvHD;活动性中枢神经系统受累;活动性乙肝、丙肝或HIV感染;室内空气血氧饱和度≤90%;胆红素>正常值上限3倍;GFR<30 mL/min;心功能不全;接受无法停用的超生理剂量皮质类固醇;已知对ATIMP任何成分过敏;存在淋巴细胞清除治疗或按当地药品说明书使用环磷酰胺/氟达拉滨的禁忌;妊娠或哺乳;预期寿命<3个月;暴发性或快速进展性疾病。
Key Inclusion Criteria: * Relapsed or refractory T-ALL/T-LBL following at least one (≥18 years old) or two (\<18 years old) standard prior lines of combination cytotoxic therapy * CCR9-positive disease as assessed by flow cytometry * T-LBL patients only: Patients must have measurable disease * Agreement to have a pregnancy test, use adequate contraception (if applicable) * Written informed consent Key Exclusion Criteria: * ECOG performance score \>2 (patients aged ≥10 years old) OR Lanksy score ≤50% (patients aged \<10 years old) * Stem Cell Transplant patients only: active significant acute GvHD or moderate/severe chronic GvHD requiring immunosuppressive therapy and/or systemic steroids * Active CNS involvement of disease * Active hepatitis B, C or HIV infection * Oxygen saturation ≤90% on air * Bilirubin \>3 x upper limit of normal * GFR \<30 ml/min * Cardiac dysfunction * Patients receiving corticosteroids at a supraphysiological dose that cannot be discontinued * Known allergy to any component of the ATIMP * Any contraindications to lymphodepletion or to the use of cyclophosphamide or fludarabine as per local SmPC * Women who are pregnant or breastfeeding * Life expectancy \<3 months * Fulminant or rapidly progressive disease
以上为辅助阅读译文。是否适合入组须由主治医生判断,最终以登记平台与研究者确认为准。
主要终点:Feasibility of generation of CARCCR9 T cells as evaluated by the number of therapeutic products generated. · To determine the feasibility of semi-automated autologous CARCCR9 T cells manufacture in patients with r/r T-ALL/T-LBL, in the setting of a Phase I trial. · 2 years;Incidence of treatment-related adverse events (safety and tolerability) · Incidence of grade 3-5 toxicity causally related to the ATIMP. · From CAR T cells infusion until 28 days post infusion
次要终点:Persistence of CARCCR9 T cells;Expansion of CARCCR9 T cells;Potential efficacy of CARCCR9 T cells;Potential efficacy of CARCCR9 T cells;Time to disease progression;Event free survival;Overall survival
患者将接受自体抗CCR9 CAR-T细胞静脉输注。
本临床试验评估使用患者自体血细胞制备的抗CCR9 CAR-T细胞在儿童和成人T细胞白血病/淋巴瘤患者中的安全性并确定适宜剂量。采集参与者T细胞并在专门实验室制备CAR-T细胞;输注前一周住院接受短程预处理化疗;随后静脉输注CAR-T细胞并住院至少2周密切观察。出院后返院复查,前两年约12次。筛选、治疗和随访期间进行体格检查、采血、骨髓活检和/或影像检查。
The goal of this clinical trial is to learn if anti-CCR9 CAR T cells (which will be made using the patient's own blood cells) are safe and which dose should be used in children and adults with T cell leukaemia and lymphoma. Participants will: * have T cells collected from their blood and these T cells will be used to make the CAR-T cells in a specialized laboratory. * be admitted at the hospital a week before the CAR T cells infusion to receive a short course of chemotherapy drugs which prepare the body to receive the CAR T cells. * be given the CAR T cells into their vein. * stay in the hospital for a minimum of 2 weeks to be closely monitored * following discharge, participants will come to the clinic for check-ups (approximately 12 visits in the first two years) * during screening, treatment and follow up visits, participants will have physical examination, collection of blood samples and bone marrow biopsies and/or imaging tests (CT/PET-CT scans) depending on their type of T-cell cancer.
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